aMMP-8 is an early risk marker for hidden degradation of gingival, periodontal and/or peri-implant soft and hard tissue - often before signs of inflammation or attachment loss become clinically visible. PerioSafe immunological preventive diagnostics based on aMMP-8 detection can therefore provide indications of the risk of progressive destructive disease of the periodontium, which may only be objectifiable weeks or months later using a probe or X-ray.

What exactly is aMMP-8 and what is its function?
aMMP-8 stands for 'activated matrix metalloproteinase 8'. This is an endogenous collagenase-degrading enzyme. Collagenases, such as aMMP-8, are found almost everywhere in the human body; 23 different human MMPs have been identified to date. These enzymes are required for physiological development and remodeling processes, e.g. embryonic development, wound healing, nerve growth and angiogenesis. MMPs are also involved in most pathological processes, including arthritis, tumor diseases, cardiovascular diseases, wound healing and periodontitis.

What role does aMMP-8 play in the development of periodontitis/peri-implantitis?
Bacteria in the dental biofilm release bacterial waste products that can irritate the gums. As soon as the periodontal tissue starts an inflammatory reaction, endothelial cells, fibroblasts and, above all, neutrophil granulocytes activate and secrete the enzyme MMP-8, which "cuts" the dense network of collagen fibers so that immune cells can move more easily to the site of infection. Like a "machete in the collagen jungle", aMMP-8 paves the way for granulocytes, macrophages and osteoclasts.
Depending on various factors (e.g. genetics, general state of health, smoking, hormonal changes, stress, diabetes, etc.), a chronic overreaction to the bacterial attack can occur. This can lead to a chronic overreaction to the bacterial attack. During the development of periodontitis, the balance shifts in favor of the aMMPs, which are subsequently present in increased active concentrations. aMMP-8 is the only enzyme of the metalloproteinases that is able to cleave both type I and type III collagen. The correlation of increased concentrations of aMMP-8 in saliva and GCF/PISF in periodontitis patients has led to the establishment of aMMP-8 as a biomarker in recent years (Sorsa et al. 2006, Sapna et al. 2014).

How does aMMP-8 get into saliva?
aMMP-8 is considered one of the most important interstitial collagenases in the context of periodontal tissue destruction. In periodontally diseased patients, aMMP-8 is found in increased concentrations not only in the gingival tissue but also in the sulcus fluid. This is continuously released as a filtrate of the serum at the tooth neck between the tooth and gum and is successively released into the saliva. In this way, aMMP-8 can be detected diagnostically with the PerioSafe test systems in the GCF/PISF (gingival crevicular fluid/peri-implant sulcus fluid) and in saliva.

What is aMMP-8 measured for?
aMMP-8 is the key enzyme for tissue destruction in the context of periodontitis. In its active form, it degrades fibrillar collagen structures and is also associated with alveolar bone destruction. The release of aMMP-8 is currently the only evidence of whether the tissue is undergoing collagenolytic degradation or is stable at the time of measurement. This makes aMMP-8 an objective, diagnostic marker for detecting the point at which periodontal tissue is degraded and also a marker for peri-implant tissue destruction.

PerioSafe can help to indicate previously undetected periodontal inflammation, particularly in at-risk groups. This allows prophylaxis to be initiated at an early stage, ideally before symptoms occur.

What information can the aMMP-8 test PerioSafe/ImplantSafe provide?
aMMP-8 is not an inflammatory marker, but a "destruction marker", i.e. a biomarker for acutely present, acutely progressing tissue decay, which can only be objectified weeks or months later by means of X-ray or probe. The aMMP-8 test thus closes the gap between conventional diagnostic methods such as probing, blood on probing (BoP), X-ray and bacterial tests.

Using the PerioSafe aMMP-8 test system, the dynamic process of active periodontal degeneration can be evaluated in saliva, on individual teeth or as a pool sample, depending on the requirements and situation, and future development can be predicted. In addition, the aMMP-8 saliva test indicates a possible genetic predisposition to active periodontal degeneration in adolescents.

An elevated level of active MMP-8 (> 20 ng/ml in saliva, gingival crevicular fluid (GCF) or peri-implant sulcular fluid (PISF)) results in the progression of active periodontal degeneration. There is an 80 to 90% probability that this progresses from gingivitis or peri-implant mucositis to periodontitis or peri-implantitis or correlates with it.

A negative test result together with unremarkable clinical dental findings is an indication of no risk or only a low risk of periodontal inflammation with tissue breakdown. Therefore, a negative test result after periodontal therapy can mean that the therapeutic measures initiated / carried out were successful.